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SAN JOAQUIN PUBLIC HEALTH ::SERVICES ' <br /> SEPTIC TANK AND CESSPOOL CLEANERS REPORT <br /> REPQRT FOR THS MONTH OF 19�SUBMITTED 8 �lJk �<. ADDRESS <br /> NAME OF ADDRESS WHERE GALLONS <br /> DATE PROPERTY OWNER WORK WAS DONE PUMPED WHERE CLEANINGS WERE UNLOADED <br /> (? (- 3 C5 <br /> i - Z 3 ) t s"� <br /> ct I S, a® <br /> 10 <br /> rrn <br /> Lupo) /51) <br /> 2.. "' d r' <br /> r X <br /> ,'` O <br /> l(— P <br /> r" M i' L a <br /> rlst -Tr <br /> �- '-yl ' a C g <br /> c S Tf wJ61 <br /> 'hu fi� j za <br /> Return by the 12th of the month to I certify under penalty of perjury that the foregoing is true and corn <br /> San Joaquin Local Health District <br /> 1601 East Hazelton Avenue J4-a, <br /> Stockton, CA 95205 DATE SIGNATURE OF UPLIMT <br /> EH 05 39 Rev. 5/82 <br />